Title : Network analysis of comorbid depression and anxiety and their associations with academic engagement among nursing students
Abstract:
Background: Nursing students often encounter mental health issues, such as depression and anxiety, which can significantly impact their academic performance and overall well-being. These challenges necessitate timely recognition and intervention to support their mental health and academic engagement. This study aims to investigate the complex relationships among depression, anxiety, and academic engagement using a network analysis approach, providing insights into how these factors interact within the context of nursing education.
Methods: A total of 618 nursing students were included in this cross-sectional study. Depression and anxiety symptoms were measured using the nine-item Patient Health Questionnaire (PHQ-9) and the seven-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Academic engagement was assessed using the Utrecht Work Engagement Scale for Students (UWES-S). A Gaussian Graphical Model (GGM) was employed to construct the networks, allowing for the visualization of symptom interactions. Central and bridge symptoms were evaluated using Expected Influence (EI) and bridge EI, respectively. The Network Comparison Test (NCT) was applied to determine whether the associations between depression and anxiety symptoms vary by gender and residential status.
Results: In the depression and anxiety network, “Fatigue”, “Guilt”, and “Difficulty relaxing” were the central symptoms. “Sad mood”, “Irritability”, and “Feeling afraid” served as the primary bridge symptoms. “Concentration”, “Anhedonia” and “Motor” exhibited the most robust correlations with academic engagement. Gender and residency did not correlate with global strength and edge weights.
Conclusions: Our findings provide a nuanced explanation of the interplay among depression, anxiety, and academic engagement in nursing students. Schools and healthcare facilities should develop targeted interventions to address these mental health challenges, particularly by focusing on the identified central and bridge symptoms. For instance, interventions could include stress management programs, counseling services, and educational strategies to improve concentration and reduce anhedonia. Additionally, alleviating symptoms of anxiety and depression can significantly enhance academic engagement, ultimately supporting the holistic development of nursing students.
